A general rule about fasting cannot be applied to all people with diabetes as the condition of each person varies depending on multiple factors: the type of diabetes, the stage of progression of the condition, the level of blood sugar fluctuations, and medication.
For example, people who tend to have very high or very low blood glucose levels are not advised to fast. Similarly, patients with type 1 diabetes who have unstable disease with co-morbid conditions are also advised against fasting.
Dr Rachna Kucheria, Chief-Operations and Medical Director, Diabetacare, said, “Your decision on whether to continue with fasting or refrain from it should depend completely on your doctor’s medical advice. If you are not fit enough to fast, your doctor will explain to you in detail the potential risks of fasting. On the other hand, if they believe your condition allows you to continue the fast, they would advise you to change your medication, adjust the levels of insulin to meet the body’s requirements during fast and recommend dietary changes and activity patterns you must follow during non-fasting hours.”
A wide scale epidemiological study conducted across 13 Islamic countries and published in Diabetes Care Journal in 2004 provided rough prevalence estimates of fasting among diabetic patients in these countries.
The study estimated that around 43 percent of type 1 diabetes and 86 percent of type 2 diabetes patients fasted during Ramadan. Covering 12,243 individuals with diabetes who fasted during Ramadan, the study found that while the overall incidence of hypoglycemic events (falling blood sugar levels) was low, severe hypoglycemia instances were more frequent during Ramadan, indicating a higher link between fasting and hypoglycemia.